Prolactin

PRL derives from the anterior pituitary gland and its secretion is tonically inhibited by the hypothalamus through a balance of hypothalamic prolactin-inhibiting hormone (PIH) and putative prolactin-releasing hormone (PRH) (28). PIH is actually dopamine; so, anything that interferes with dopamine production results in increased PRL (the most common pathological reason being the use of many drugs used in psychiatry, e.g., risperidone and the phenothiazines).

Elevated PRL in men (and women) results in diminished sexual desire, as well as the possibility of erection and/or ejaculatory problems in the form of diminished volume. In a very informative study of men presenting to a clinic because of sexual disorders and who were later found to be hyperprolactinemic, Schwartz et al. (29) concluded that it was generally futile to attempt to separate "psychogenic" and "organic" sexual problems, because many of the men presented with a situational pattern that seemed to be exacerbated by psychological factors and that improved at times of increased arousal. Even more striking (and a sobering lesson to those who are not flexible in their approach to treating sexual problems in men), sex therapy administered before the hyperprolactinemia was discovered, actually resulted in improvement!

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